• World Neurosurg · Oct 2021

    The Impact of Incorporating Evidence-based Guidelines for Lumbar Fusion Surgery in Neurosurgical Resident Education.

    • Fadi Al Saiegh, Lucas Philipp, Liam P Hughes, Thiago Scharth Montenegro, Kevin Hines, Glenn A Gonzalez, Aria Mahtabfar, Carrie Andrews, Kavantissa Keppetipola, Daniel Franco, Karim Hafazalla, Omaditya Khanna, Nikolaos Mouchtouris, Dwight Mitchell Self, Joshua Heller, Srinivas Prasad, Jack Jallo, Ashwini D Sharan, and James S Harrop.
    • Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA. Electronic address: fadi.al-saiegh@jefferson.edu.
    • World Neurosurg. 2021 Oct 1; 154: e382-e388.

    BackgroundInstrumented fusion procedures are essential in the treatment of degenerative lumbar spine disease to alleviate pain and improve neurological function, but they are being performed with increasing incidence and variability. We implemented a training module for neurosurgery residents that is based on evidence-based criteria for lumbar fusion surgery and measured its effectiveness in residents' decision making regarding whether patients should or should not undergo instrumented fusion.MethodsThe study design was a pretest versus posttest experiment conducted from September 2019 until July 2020 to measure improvement after formalized instruction on evidence-based guidelines. Neurosurgery residents of all training levels at our institution participated. A test was administered at the beginning of each academic year. The highest possible score was 18 points in each pretest and posttest.ResultsThere was a general trend of test score improvement across all levels of training with a greater degree of change for participants with lower compared with higher pretest scores, indicating a possible ceiling effect. Paired t test demonstrated an overall mean score increase of 2 points (P < 0.0001), equivalent to an 11.11% increase (P < 0.0001). Stratified by training group, mean absolute change in test score was 2 (P = 0.0217), 1.67 (P = 0.0108), and 2.25 (P = 0.0173) points for junior, midlevel, and senior training groups, respectively.ConclusionsIncorporating a targeted evidence-based learning module for lumbar spine fusion surgery can improve neurosurgery residents' clinical decision making toward a more uniform practice supported by published data.Copyright © 2021 Elsevier Inc. All rights reserved.

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